Tanveer Shafqat, Shandana Bawar, Khawaja Fawad Pervez.
Seven Years Experience of Surgical Management of Vesicovaginal Fistula at Regional Centre in Khyber Pakhtoon Khwa (KPK).
Pak J Med Health Sci Jan ;7(4):1210-3.

Aim: To review our experience in the management of GUF over seven years period with emphasis on causes and outcome of surgical management. Methods: This study was carried out at Regional Fistula Center, Lady Reading Hospital, Peshawar, KPK. This study included all the patients with VVF from Jan 2006 to Dec 2012. During this period we received 180 patients suffering from vesicovaginal fistula (VVF). We excluded the patients with ureterovaginal fistula and fistula secondary to malignancy or radiotherapy. Results: One hundred and eighty cases were included in the study. The mean age was 35(15-55) years with parity ranging from one to nine. Obstetric cause was found in 81.66% cases, while 18.33% developed VVF secondary to gynaecological surgery. 89.3% women came from rural areas and 92.90% belonged to low socioeconomic strata of society. The commonest site of fistula was anterior vaginal wall (45%) and vault (27.22%). Size of fistula varied from 0.3cm to 5 cm. Obstructed labour contributed to 86(58.50%) cases while ruptured uterus ending in subtotal abdominal hysterectomy (STAH) accounted for 25(17%) cases. Instrumental delivery and Caesarean section contributed to 12.9% and 11.6% cases. Gynaecological fistula was seen in 33(18.3%) women. Transvaginal repair was done in 131(72.77%) cases and transabdominal route was chosen in 49(27.22%) cases. Successful surgical repair was reported in 85.55% case. Conclusion: VVF is mainly caused by obstetrical complications. Despite its impressive outcome of surgical repairs, emphasis should be shifted towards the prevention of this devastating condition.

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